This thesis provides analytical insights on conditions under which policy actors such as bureaucrats, politicians, international donors, service providers, and the public are able to influence and take public maternal health policy agenda decisions in Ghana over a five decade period. Understanding these decisions is of great importance because they influence which concrete measures are put in place and how they are implemented to improve health outcomes. The research unpacks how and why these decisions such as maternal healthcare fee exemptions and free access to family planning came about under varied policy actors confronted with national and international pressures. The research points to how policy actors used money, evidence, social and political power to move policy ideas in specific directions such that a policy item on the national agenda can still fail to move into formulation and implementation when left without maintenance